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Discontinuing digoxin may harm hospitalized patients with HFrEF
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Among patients hospitalized for HF with reduced ejection fraction, discontinuation of digoxin was associated with worse outcomes compared with remaining on digoxin, researchers reported.
From a cohort of 3,499 patients from the OPTIMIZE-HF registry who were admitted for HFrEF while already on digoxin, the researchers compared outcomes between those who discontinued digoxin and those who did not.
After propensity matching, the study population consisted of 698 patients who discontinued digoxin and 698 who stayed on it (mean age, 76 years; 41% men; 13% black; mean EF, 28%; 65% on beta-blockers).
At 4 years after discharge, compared with the group who stayed on digoxin, the group who discontinued it had higher risk for HF readmission (HR = 1.21; 95% CI, 1.05-1.39), all-cause readmission (HR = 1.16; 95% CI, 1.04-1.31) and HF readmission/all-cause mortality (HR = 1.2; 95% CI, 1.07-1.34), Awais Malik, MD, internal medicine resident at Georgetown University, and colleagues wrote.
There was no significant difference between the groups in all-cause mortality at 4 years (HR = 1.09; 95% CI, 0.97-1.24), according to the researchers.
At 30 days, the discontinuation group had higher risk for all-cause mortality (HR = 1.8; 95% CI, 1.26-2.57) and HF readmission/all-cause mortality (HR = 1.36; 95% CI, 1.09-1.71) but not HF readmission or all-cause readmission, and at 6 months and 1 year, the discontinuation group had higher risk for HF readmission, all-cause readmission, HF readmission/all-cause mortality and all-cause mortality, Malik and colleagues wrote.
“To the best of our knowledge, this is the first report of adverse outcomes associated with discontinuation of pre-admission digoxin therapy in a propensity score-matched cohort of hospitalized older patients with HFrEF receiving contemporary [guideline-directed medical therapy] including ACE inhibitors/[angiotensin receptor blockers], beta-blockers and [mineralocorticoid receptor antagonists],” the researchers wrote.
“The current study suggests that we may have prematurely abandoned this drug class before its role in the treatment of HFrEF in the modern era has been completely delineated,” Barry F. Uretsky, MD, and Srikanth Vallurupalli, MD, both from Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, wrote in a related editorial. – by Erik Swain
Disclosures: The OPTIMIZE-HF registry was sponsored by GlaxoSmithKline, but the sponsor played no role in the present study. Malik, Uretsky and Vallurupalli report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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